The neuropsychiatry of multiple sclerosis: Focus on disorders of mood, affect and behaviour

Abstract

Neuropsychiatric symptoms are common in multiple sclerosis (MS). They include two broad categories of disturbances: abnormalities in cognition, and abnormalities of mood, affect and behaviour. The present review deals with the epidemiology, clinical features, etiology and treatment of disturbances included in the second category, i.e., major depression, fatigue and sleep disorders, bipolar disorder, euphoria, pathological laughing and crying, anxiety, psychosis and personality changes. Major depression is one of the most common neuropsychiatric disorders in MS with an approximate 50% lifetime prevalence rate. Early recognition and management of depression in MS is of major importance because it is a key predictor of morbidity, mortality, quality of life, possibly physical outcome and disease exacerbations, adherence to immunomodulatory treatments and suicide risk in MS patients, as well as of the caregiver's distress and quality of life. The etiopathogenesis of neuropsychiatric disorders in MS has been incompletely investigated. It is postulated that a complex interplay of biological, disease-related, behavioural and psychosocial factors contribute to the pathophysiology of most of them. Management of neuropsychiatric symptoms in MS is often effective, although commonly based on evidence provided by case studies and uncontrolled trials. A comprehensive biopsychosocial neuropsychiatric approach is essential for the optimal care of patients with MS.

The Effect of Type D Personality on Quality of Life in Patients with Multiple Sclerosis

“…Personality changes may occur in patients with MS (9,27). Demyelinating lesions are suggested to give rise to the personality changes by affecting the frontal-subcortical circuits and limbic structures (28).…”

Clinical experience with repository corticotropin injection in patients with multiple sclerosis experiencing mood changes with intravenous methylprednisolone: a case series

“…The available data support an association between corticosteroid treatment and mood disorders as well as other neuropsychiatric disorders such as sleep disturbances, cognitive impairment, and psychosis in some patients [Iacovides and Andreoulakis, 2011;Klein, 1992;Lewis and Smith, 1983;Lienert et al 2013;Martinelli et al 2009;Paparrigopoulos et al 2010;Sellebjerg et al 1998;Sorensen et al 2009;Tsang and Macdonell 2011;Warrington and Bostwick, 2006]. Commonly occurring nonpsychiatric AEs for corticotropin injection are similar to those of corticosteroids, as related to stimulation of cortisol release, and include fluid retention and edema, possible change in glucose tolerance, elevated blood pressure, and increased appetite and weight gain.…”

“…Potential reasons for the elevated rates of neuropsychiatric disorders and symptoms in patients with MS include the physiological changes inherent in the disease, side effects of MS treatments, and psychological responses to their diagnosis or symptoms [Iacovides and Andreoulakis, 2011;Paparrigopoulos et al 2010]. Regardless of the potential causes, patients with MS should be evaluated for mood disorders and neuropsychiatric symptoms and the findings should be taken into account when determining treatment [Lienert et al 2013;Marrie et al 2009;Paparrigopoulos et al 2010].…”

“…Regardless of the potential causes, patients with MS should be evaluated for mood disorders and neuropsychiatric symptoms and the findings should be taken into account when determining treatment [Lienert et al 2013;Marrie et al 2009;Paparrigopoulos et al 2010]. When possible, therapeutic options for MS exacerbations should be chosen for each patient with the goals of minimizing the risks of neuropsychiatric side effects or exacerbation of pre-existing conditions.…”

“…Treatment for exacerbations of MS has generally consisted of intravenous (IV) corticosteroids, usually methylprednisolone (MP), oral steroids, or repository corticotropin injection (HP Acthar ® gel, Mallinckrodt ARD Inc., Hazelwood, MO, USA) [Filippini et al 2000;Tsang and Macdonell, 2011]. Both MP and corticotropin (adrenocorticotrophic hormone [ACTH]) have demonstrated efficacy in reducing short-term disability after exacerbations of MS [Filippini et al 2000;Iacovides and Andreoulakis, 2011;Lienert et al 2013;Martinelli et al 2009;Paparrigopoulos et al 2010;Tsang and Macdonell, 2011].…”